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Utilisation of outpatient cardiac rehabilitation in Queensland
Ian A Scott1, Kylie A Lindsay, Hazel E Harden
1Department of Internal Medicine, Level 5, Medical Specialties, Princess Alexandra Hospital, Mail Drop Bag 69, Woolloongabba, QLD 4102, Australia. ian_scott@health.qld.gov.au
Insights
Patient participation in outpatient cardiac rehabilitation (OCR) programs is low, with significant underutilization of available places. Improved referral and compliance strategies are needed for these vital cardiac rehab services.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Outpatient cardiac rehabilitation (OCR) is crucial for post-cardiac event recovery and secondary prevention.
- Current participation and completion rates in OCR programs require evaluation to identify areas for improvement.
Purpose of the Study:
- To assess patient referral and participation rates in outpatient cardiac rehabilitation (OCR) programs in Queensland.
- To identify barriers affecting patient access and adherence to OCR.
- To evaluate the quality and utilization of existing OCR program resources.
Main Methods:
- A retrospective cohort study analyzed patient data from 31 Queensland hospitals (public and private) between July 1999 and June 2000.
- Questionnaire surveys were administered to hospitals and all registered OCR programs to gather data on referrals, attendance, and program capacity.
Main Results:
- Only 29% of eligible patients were referred to OCR programs, significantly lower than the estimated 59% eligibility rate.
- Referral rates varied by hospital type, with private hospitals showing higher referral percentages (52%) compared to public hospitals (20%).
- Fewer than a third of referred patients completed OCR programs, and only 39% of program capacity was utilized, with areas of underutilization experiencing higher coronary mortality.
Conclusions:
- Significant underutilization of facility-based OCR programs exists in Queensland, indicating a gap in service delivery.
- There is a need for improved patient identification and referral processes to existing OCR programs.
- Enhancing patient compliance and exploring alternative models for cardiac rehabilitation delivery are essential to address current deficits.
Objectives:
To determine patient participation rates in outpatient cardiac rehabilitation (OCR) programs; ascertain the barriers to participation; and evaluate the quality of OCR programs.
Design And Setting:
Retrospective cohort study of patient separations from selected public and private Queensland hospitals; questionnaire survey of hospitals and all registered OCR programs.
Participants:
Patients discharged with cardiac diagnoses between 1 July 1999 and 30 June 2000 from 31 hospitals (24 public; 7 private).
Main Outcome Measures:
Rates of referral of hospitalised patients to OCR programs; rates of program attendance and completion; barriers to OCR referral and attendance.
Results:
15 186 patients were discharged with cardiac diagnoses from participating hospitals, of whom 4346 (29%) were referred to an OCR program after discharge, compared with an estimated 59% (8895/15 186) of patients who were eligible for such a program. Proportionately more patients were referred from secondary (38% [1720/4500]) and private (52% [2116/4031]; P < 0.001) hospitals than from tertiary (25% [2626/10 686]) and public (20% [2230/11 155]) hospitals. Patients undergoing coronary revascularisation procedures comprised 35% of discharges, but accounted for 56% of all program attendances. Fewer than a third of all referred patients completed OCR programs, and only 39% of available OCR program places were fully utilised. Catchment populations of programs with unused places had excess coronary mortality.
Conclusion:
There is significant underutilisation of facility-based OCR programs in Queensland. Procedures are required for identifying and referring eligible patients to existing programs and improving program compliance. Alternative OCR models are also required.
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